A MORPHOMETRIC STUDY OF THE SELLA TURCICA; GENDER EFFECT
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International Journal of Anatomy and Research,
Int J Anat Res 2015, Vol 3(1):927-34. ISSN 2321- 4287
Original Article DOI: http://dx.doi.org/10.16965/ijar.2015.118
A MORPHOMETRIC STUDY OF THE SELLA TURCICA; GENDER
EFFECT
Ashraf Mohamed Elsayed Ali SAKRAN * 1 , Mohammad Afzal KHAN 2, Faris
Mohammed Nour ALTAF 3, Hassan Elsiddig Hassan FARAGALLA 4, Amal Yousif
Ahmed Elhaj MUSTAFA 5, Muhammad Mazhar HIJAZI 6, Rayan Abdulshakur NIYAZI
7
, Abrar Jamal TAWAKUL 8, Abeer Zubair MALEBARI 9, Amal AbdulAziz SALEM 10.
1,2,3,5,6
Department of Human Anatomy, Faculty of Medicine, Umm al Qura University, Makkah, Saudi
Arabia.
4
Department of Public Health, Health Sciences College at Al.leith, Umm al Qura University, Saudi
Arabia.
7,8,9,10
Medical students, Faculty of Medicine, Umm al Qura University, Makkah, Saudi Arabia.
ABSTRACT
Background and objective: Precise anatomical knowledge of the sella turcica is important for neurologists and
surgeons operating in the region of cavernous sinus or the surrounding structures. The current study was
undertaken to record normal morphometric parameters for future reference and to determine if there is any
significance difference in the sella turcica morphometry regarding the gender.
Methodology: A Morphometric analysis of the Sella Turcica and structures in vicinity were done in thirty six
adults’ formalin fixed cadaver’s skulls (22 male and 14 female).
Results: The pituitary stalk positions were middle in majority of male cases (72.7%), the remaining 27.3% were
posterior. Among female; 57.1% were middle and the remaining 42.9% were posterior, no anterior position was
detected among both genders with no different between male and female (p = 0.494) Normal Optic chiasma
position was detected in all female cases and in 63.6% of male cases with no significant differences regarding
gender (p= 0.070). No significant different in diaphragma sella shape and opening regarding gender (p.value =
0.170 and 0.914 respectively) No significant difference between males and females concerning linear dimensions
of sella turcica (length, depth and Anteroposterior diameters). Concerning diaphragma sella opening; no
significant different regarding gender in transverse diameter (p.value= 0.316) while significant different was
detected in anteroposterior diameter (p.value= 0.046) For interclinoid (anterior, posterior) diameters, which
represented statistically significant different regarding gender in both right and left sides (p.value = 0.004 and
0.001 respectively).
Conclusion: Present study will providing the normal morphometric data for future reference and further studies.
KEY WORDS: Sella turcica, Morphometry, Gender.
Address for Correspondence: Dr. Ashraf M. E.A. Sakran, Department of Human Anatomy, Faculty
of Medicine, Umm al Qura University, P.O. Box: 7607, Makkah, Saudi Arabia.
Phone: 00966568841873 or 00249912254379 E-Mail: ashrafsakran@hotmail.com
Access this Article online
Quick Response code Web site: International Journal of Anatomy and Research
ISSN 2321-4287
www.ijmhr.org/ijar.htm
Received: 13 Feb 2015 Accepted: 26 Feb 2015
Peer Review: 13 Feb 2015 Published (O):31 Mar 2015
DOI: 10.16965/ijar.2015.118 Revised: None Published (P):31 Mar 2015
INTRODUCTION two posterior clinoid processes. It is composed
The sella turcica, a saddle shaped depression of three parts: the tuberculum sellae, pituitary
in the upper surface of sphenoid bone is located (or hypophysial) fossa which lodging the
between and bounded by the two anterior and pituitary gland and the dorsum sellae [1,2].
Int J Anat Res 2015, 3(1):927-34. ISSN 2321-4287 927Ashraf Mohamed Elsayed Ali SAKRAN et al. A MORPHOMETRIC STUDY OF THE SELLA TURCICA; GENDER EFFECT.
The pituitary gland is covered on its superior Thorough knowledge on anatomy of sellar region
surface by the diaphragma sellae, which is a fold is important to neurologists and neurosurgeons
of dura matter attached to the anterior and dealing with pathologies in this region.
posterior clinoid process. Central part of the Recognizing variations is important in preventing
diaphragma sellae is pierced by an opening for damage during surgery [12]. Also sella turcica
pituitary stalk [2]. The lesser wing of the is of importance because within its center lies
sphenoid bone is prolonged posteromedially to the sella point which helps evaluating of
form the anterior clinoid processes. craniofacial morphology [15]. The purpose of
The posterior clinoid processes are located at this study was to measure the dimensions,
the superolateral angles of the dorsum sellae. shape and the incidence of abnormalities of the
Inconstant and variable the middle clinoid sella turcica in skulls so as to contribute towards
processes are located posterolateral to the establishing reference standards that could
tuberculum sellae [1,3]. Occasionally the assist in a more objective evaluation and
anterior and posterior clinoid process may fuse detection of pathological conditions and
to form what is termed as a sella turcica bridge possibly help in operative procedures in this
[3]. Similarly the middle clinoid process may at region.
times be fused with the anterior clinoid process MATERIALS AND METHODS
by a thin and small bony spicule to form a
caroticoclinoid foramen [4]. Normal data on the The study was conducted on 36 adult formalin
size and various dimensions has been described fixed cadaver’s skulls (22 male and 14 female),
in the literature [5,6]. Changes in the size of the at the Department of Human Anatomy, Faculty
sella turcica, however, are frequent and are of Medicine, Umm al Qura University, Makkah.
related to pathology in this region. An The pituitary gland and the sellar region were
enlargement in size not accompanied by bony observed after removal of the calvaria and brain.
erosion is usually found in intrasellar adenomas It will be checked that the subjects had no
[7,8] and the empty sella sendrome [9]. Other surgery or extensive disease involving the area
not so common causes of enlargement may under study. The position of pituitary stalk and
include Rathke’s cleft cysts and aneurysms [7]. optic chiasma, shape of diaphragm sellae and
An uncommon small sella turcica may be seen its opening were recorded. Linear measurements
in primary hypopituitarism, growth hormone of sella turcica in the mid-sagittal plane were
deficiency, and William’s syndrome [10,11]. done by using Vernier calipers (General Tools
Mfg. Co. LLC New York, NY 10013). Sellar
Three different positions of the pituitary stalk
opening, transverse diameter (SOTR) and sellar
have been described: anterior when it is close
opening, antero-posterior diameter (SOAP) were
to tuberculum sellae; middle when central to
recorded in millimeters. After careful removal
diaphragm sellae; posterior where it is close to
of the pituitary gland along with its stalk the
dorsum sellae [12]. The relationship of the sella
length of sella turcica (STL) was obtained by
turcica with the optic chiasma has been
measuring the distance between the tubercu-
classified into ‘prefix’ in which the optic chiasm
lum sellae to the tip of dorsum sellae. The depth
is located on top of the tuberculum sellae,
of sella turcica (STD) was measured at the deep-
‘normal’ in which the optic chiasm is located on
est part of sella and is at right angle to the
the top of diaphragma sellae and the ‘postfix’
direction of length of sella turcica (STL). Also
variety where the optic chiasma is located on
the antero-posterior diameter of sella turcica
top of the dorsum sellae [13]. The diaphragma
(STAP) was measured by line drawn from the
sellae, a small horizontal fold of dura that forms
tuberculum sella to the most posterior point on
roof of pituitary when viewed from above has
the posterior inner wall of the pituitary fossa
three different shapes: convex, concave, and flat
(figure 1). The anterior, middle and posterior
[12,13]. Diaphragma sella has a central aperture
clinoid processes were observed for any anoma-
of variable size, ranging from small foramen to
lies (sella turcica bridging or caroticoclinoid
a large hole which transmits the pituitary stalk
foramen).
and its blood vessels [14].
Int J Anat Res 2015, 3(1):927-34. ISSN 2321-4287 928Ashraf Mohamed Elsayed Ali SAKRAN et al. A MORPHOMETRIC STUDY OF THE SELLA TURCICA; GENDER EFFECT.
The maximum transverse distance between the normal and 22.2% were postfixed, insignificant
two posterior clinoid processes (PCPTR), the different regarding gender was found (p.value =
maximum height of the posterior clinoid 0.070).
processes (PCPL) and the distance between Regarding the shape of diaphragma sellae
anterior clinoid processes and posterior clinoid among study group; 72.2% were concave, 16.7%
processes (left side) and (right side) (CPD) were convex and 11.1% were flat with no significant
measured. All the measurements were recorded different regarding gender (p.value = 0.170).
in millimeters.
Insignificant different concerning the shape of
Ethical consent: The study was approved by the diaphragma sella opening regarding gender was
biomedical ethics committee, faculty of found (p.value = 0.914); 57.1% of the female
medicine, Umm Al-Qura University, Makkah, cases were elliptic shape and 42.9% were round,
Saudi Arabia. 54.5% of the male were elliptic and 45.5% were
Statistical analysis: For all statistical analyses, round shape.
the SPSS statistical software version 15 was The mean length of sella turcica for female was
used. The ANOVA and Pearson chi square tests 11.57 mm and for male 10.77 mm. The mean
were used and P. values of 0.05 or less were depth of sella turcica for female was 9.5 mm
regarded as statistically significant. and in male 10.05 mm. The mean
Fig 1: Showing reference lines and bony landmarks used anteroposterior diameter of sella turcica for
for measuring of sella turcica size. TS, tuberculum sella; female was 11.57 mm and in male 11.23 mm,
DS, dorsum sella; BPF, base of the pituitary fossa; ACP, the present study revealed insignificant
anterior clinoid process; PCP, posterior clinoid process;
green line, length of sella turcica ; yellow line, antero-
statistically difference in the length, depth and
posterior diameter of sella; blue line, depth of sella; red anteroposterior diameter of sella turcica
line, distance between anterior and posterior clinoid regarding gender (p.value = 0.208, 0.391and
processes. 0.471 respectively).
Linear measurements of diaphragma sella
opening were summarized in Table 6; the mean
of anteroposterior diameter for diaphragm sella
opening were 6.09 and 7.86 for the males and
females respectively, statistically significant
different regarding gender was detected (p.value
= 0.046). While for transvers diameter the means
were 7.27 and 8.57 for male and female
respectively with insignificant different (p.value
= 0.316).
The measurements of posterior clinoid process
among study group show insignificant different
regarding gender (p.value = 0.670 and 0.797) for
RESULTS AND TABLES transvers diameter PCP and Length PCP
Anatomical and morphometric observations respectively).
revealed: 66.7% of pituitary stalk position were While for interclinoid (anterior, posterior),
middle and 33.3% were posterior, insignificant statistically significant different regarding gende
different regarding gender was found (p.value = was detected in both right and left sides ( p.value
0.494); the optic chiasma position shows 77.8% = 0.004 and 0.001 respectively).
Pituitary stalk Gender Total (%)
significance
position Male (22) Female (14) position-wise
Table 1: The position of the
Anterior 0(0%) 0(0%) 0(0%) pituitary stalk in both
Posterior 6 (27.3%) 6 (42.9%) 12 (33.3%) 0.494 genders.
Middle 16(72.7%) 8 (57.1%) 24 (66.7%)
Int J Anat Res 2015, 3(1):927-34. ISSN 2321-4287 929Ashraf Mohamed Elsayed Ali SAKRAN et al. A MORPHOMETRIC STUDY OF THE SELLA TURCICA; GENDER EFFECT.
Gender
Optic chiasma Total (%)
significance
position Male (22) Female (14) position-wise
Table 2: The position of optic
Prefixed 0(0%) 0(0%) 0(0%) chiasma in both genders.
Normal 14(63.6%) 14(100%) 28(77.8%) 0.07
Post-fixed 8(36.4%) 0(0.00%) 8(22.2%)
Diaphragma Gender Total (%)
significance
sella shape Male (22) Female (14) position-wise Table 3: The shape of
diaphragma sella in both
Concave 18(81.8%) 8(57.1%) 26(72.2%)
genders.
Convex 4(18.2%) 2(14.3%) 6(16.7%) 0.17
Flat 0(0%) 4(28.6%) 4(11.1%)
Shape of diaphragm Gender
significance
sella opening Male (22) Female (14) Table 4: The shape of diaphragma sella open-
ing in both genders.
Elliptic 12(54.5%) 8(57.1%)
0.914
Round 10(45.5%) 6(42.9%)
Table 5: Linear measurements of sella turcica size in both genders (in millimeter).
Measurements Gender N Mean STD Minimum Maximum significance
Female 14 11.57 0.08864 10.5 13
Length 0.208
Male 22 10.77 0.14381 8.5 13.5
Female 14 9.5 0.13229 8 11.5
Depth 0.391
Male 22 10.05 0.12541 8 12
Anteroposterior Female 14 11.57 0.08381 10 12.5
0.471
diameter Male 22 11.23 0.10335 9 12.5
Table 6: Linear measurements of diaphragma sella opening in both genders (in millimeters).
Measurements Gender N Mean STD Minimum Maximum significance
Anteroposterior Female 14 7.86 0.1069 6 9
0.046
diameter Male 22 6.09 0.19725 4 9
Transvers Female 14 8.57 0.11339 7 10
0.316
diameter Male 22 7.27 0.31652 4 12
Table 7: The measurements of posterior clinoid process (PCP) and the interclinoid (anterior, posterior)
diameter (ICD) in both genders (in millimeters).
Measurements Gender N Mean STD Minimum Maximum significance
Transvers Female 14 14.93 0.62877 7 23
0.67
diameter PCP Male 22 13.86 0.41719 10 22.5
Female 14 8.93 0.14268 7 11
Length PCP 0.797
Male 22 9.14 0.1762 6 11.5
Female 14 9.14 0.17008 7 12
ICD right side 0.004
Male 22 7.09 0.08893 5 8.5
Female 14 8.43 0.12392 7.5 11
ICD left side 0.001
Male 22 6.18 0.10553 4 8
Int J Anat Res 2015, 3(1):927-34. ISSN 2321-4287 930Ashraf Mohamed Elsayed Ali SAKRAN et al. A MORPHOMETRIC STUDY OF THE SELLA TURCICA; GENDER EFFECT.
Two cases have caroticoclinoid foramen in both Similar results were found in the Indian
sides (figure2). * population [18].
Fig. 2: Shows present of caroticoclinoid foramen in both Three different positions of optic chiasma have
sides.
been described: prefixed, normal and post- fixed
[12,13]. Rhoton [13] reported prefixed position
in 15% of the patients, normal in 70% and post-
fixed position in15%. Gulsen S, Dinc AH et. al.
[12] found the values to be 5% for prefixed
position, 78% normal and 17% for post-fixed. Our
study shows that the normal position is
approximately similar to the previous studies
(77.8%) but post-fixed position was higher
(22.2%) and the prefixed position was absent.
In Indian population [18] in the post-natal
cadavers the percentage incidence of pre- fixed
was higher in females and post-fixed and normal
positions were higher in males. In our study the
TS- tuberculum sella; DS- dorsum sella; PF- pituitary incidence of normal position was higher than
fossa; ACP- anterior clinoid process; PCP- posterior the prefixed and post-fixed positions in both sex.
clinoid process; MCP- middle clinoid process.
The prefixed and post-fixed positions were
DISCUSSION absent in female.
The shape of diaphragm sellae was described
The importance of understanding the anatomy as concave in 80.1%, convex in 13.2% and 6.7%
of sellar region and its variations is important flat for Chinese population [17]. This study
to neurologists and neurosurgeons dealing with obtained nearly similar values as in Chinese
pathologies in this region [12,16,17]. Also sella population. In Indian post-natal cadavers the
turcica is of importance because within its center percentage incidence of flat, concave and
lies the ‘sella point’ which helps in evaluation convex appearance for diaphragm sellae was
of craniofacial morphology [15]. 48.44%, 40.63% and 10.93% respectively [18].
Three anatomical positions for pituitary stalk When analyzed sex wise it shows, concave
have been described in the literature: anterior, appearance was higher in both sexes (81.1% for
middle and posterior in relation to the sella male and 57.1% for female), convex shape was
turcica; the middle position being the commonest higher in male ( 18.2% for male and 14.3% for
[12,16]. Four different locations for pituitary stalk female) and flat shape was 28.6% in female
are reported in Turkish population with and absent in male.
percentage incidence of anterior (13%), middle The shape and diameters of diaphragma sella
(40%) posterior (40%) and prominent tuberculum opening are variable. It is either elliptical or
sellae (7%) [12]. In a Chinese cadaveric study a round in shape. Its size is important for
percentage incidence of anterior (53.3%), middle protection of the optic chiasma fibers in cases
(40%) and posterior (6.7%) positions were of suprasellar extension of pituitary tumors and
reported [17]. In Indian postnatal cadavers the for protecting the gland from transmitted
percentage incidence was: anterior 6%, middle pulsations of choroid plexus . Variations in the
66% and posterior 28% [18]. Findings of this size and shape of the sellar opening provide
study were approximately similar as Indian explanation for direction of growth of pituitary
population with the absence of anterior position tumors towards cavernous sinus and supra sellar
but differ from Turkish and Chinese populations. region [16]. This study revealed that, the
Middle position incidence was higher in male incidence of elliptic appearance for diaphragma
(72.7%) than female (57.1%) while posterior sella opening was higher than rounded shape
position was higher in female (42.9%) than male (55.6% and 44.4% respectively). The elliptic
(27.3%).
Int J Anat Res 2015, 3(1):927-34. ISSN 2321-4287 931Ashraf Mohamed Elsayed Ali SAKRAN et al. A MORPHOMETRIC STUDY OF THE SELLA TURCICA; GENDER EFFECT. shape incidence was approximately similar in These discrepancies can be due to difference in both sexes (57.1% for female and 54.5% for method and ethnic origin. male).The values obtained in this study differs Considering the gender, the length and from those of Indian post-natal population anteroposterior diameters of sella turcica were research (40% for elliptic and 60% for round higher in female than in male while the depth appearance of diaphragm sella opening) [18]. was more in male. However there was no There were no significant differences for gender significance difference for these three in relation with the position of pituitary stalk, parameters in relation with gender. Similar optic chiasma position, shape of diaphragma results have been recorded by Alkofide and Shah sella and its opening. The sex differences for et al who reported that till the age of 17 years these parameters observed in the present study the area of sella turcica was more in males than have not been reported in the literature. in females while after the age of 17 years it was The mean of diaphragma sella opening higher in females [20]. anteroposterior diameter (SOAP) was 6.79 mm In the literature the anterior clinoid process has and ranged between 4-9 mm while its transvers received more attention because it has been used diameter mean was 7.78 mm and ranged by the surgeons, to gain entry into the clinoid between 4-12 mm. Approximately similar results space to explore the internal carotid artery and are reported for Indian post-natal population [18] other structures in vicinity [21]. The posterior (SOAP range 3-7 mm, SOTR range 4-12 mm) and clinoid process is less accessed for such Chinese population [17] (mean SOAP of 6.59 operations. Any abnormality in the posterior mm, range 2.20-12.10 mm, mean SOTR of 7.32 clinoid process may compress the surrounding mm, range 3.10-13.40 mm). When analyzed sex structures especially the internal carotid artery wise our study shows that the SOAP and SOTR and alter the attachment of the tentorium were higher in female but it was only statistically cerebelli to the posterior clinoid process. The significant for SOAP (p = 0.046). In Indian post- anterior clinoid process has been reported to be natal population [18] female SOAP and SOTR joined to the middle clinoid process by a fold of were higher but they were not statistically dura mater [21]. Sometimes this middle clinoid significant. process is connected to anterior clinoid process Sella turcica linear dimension were measured by a small bony spicule forming a foramen known using different methods and this must be taken as Carotico-clinoid Formen [4]. into consideration when comparing the results. Surgeons have to operate on the dorsum sellae Alkofide EA (2007) [5] in Saudi population using in order to expose the length of basilar artery in radiographs, found that the average for length, case of aneurysms[22]. Anatomical knowledge depth and anteroposterior diameter were (10.85 of the posterior clinoid process is important in mm, 9.1 mm and 13.95 mm) respectively. Shah order to avoid any damage to structures in AM et al [19], in Turkish population using relation. radiographs, reported that the average for There are few studies concerning the diameters length, depth and anteroposterior diameter were of the posterior clinoid process (transvers (11.35 mm, 9.9 mm and 13.90 mm) respectively. diameter and length) and the interclinoid In comparison with the previous studies, the distance in the right and left sides. Paul and Das present study shows: the mean length of sella [11] in their case report found that the maximum turcica was higher than Alkofide finding (+ 0.23 transverse distance between the two posterior mm) and smaller than Shah AM et al result (- clinoid processes (PCPTR) was 10 mm in the first 0.27 mm). The mean depth of sella turcica was case and five mm in the second one while the higher than Alkofide finding (+ 0.74 mm) and maximum height of the posterior clinoid smaller than Shah AM et al (- 0.06 mm, while processes (PCPL) was 10 mm in the first case the mean anteroposterior of sella turcica was and 11 mm in the second one. The distance smaller than Alkofide finding (- 2.59 mm) and between anterior clinoid processes and posterior Shah AM, et al. result (- 2.54 mm). clinoid processes (left side) was five mm in the Int J Anat Res 2015, 3(1):927-34. ISSN 2321-4287 932
Ashraf Mohamed Elsayed Ali SAKRAN et al. A MORPHOMETRIC STUDY OF THE SELLA TURCICA; GENDER EFFECT.
first case and 10 mm in the second one, while ACKNOWLEDGEMENTS
(right side)(CPD) was six mm in the first case
and 10 mm in the second one. This study The authors gratefully acknowledge the help
revealed that the mean of PCPTR was 14.28 mm provided by the Synergism research club for
and ranged between 7 and 23mm; the mean of medical students at the Faculty of Medicine,
the PCPL was 9.06 mm ranged between 6-11.5 UQU, Makkah, Saudi Arabia, during this study
mm. The CPD in the left side was 7.06 mm by nominating students to participate as part of
ranged between 4-11 mm, while CPD in the right their hands-on training in research.
side was 7.89 mm and ranged between 5 and12
mm. Conflicts of Interests: None
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How to cite this article:
Ashraf Mohamed Elsayed Ali SAKRAN, Mohammad Afzal KHAN, Faris Mohammed Nour
ALTAF, Hassan Elsiddig Hassan FARAGALLA, Amal Yousif Ahmed Elhaj MUSTAFA,
Muhammad Mazhar HIJAZI, Rayan Abdulshakur NIYAZI, Abrar Jamal TAWAKUL, Abeer
Zubair MALEBARI, Amal AbdulAziz SALEM. A MORPHOMETRIC STUDY OF THE SELLA
TURCICA; GENDER EFFECT. Int J Anat Res 2015;3(1):927-934. DOI: 10.16965/ijar.2015.118
Int J Anat Res 2015, 3(1):927-34. ISSN 2321-4287 934You can also read
